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agreen - June 28th, 2006 11:34 AM

Hi Dr. Smith,

Thank you for all of your extensive and candid explanations on this board. I've been lurking for awhile and have found the information I have learned on here to be both informative and encouraging.

I am 28 years old and have had a day 3 FSH in the range of 11.4 - 12.5. I "failed" the clomid challenge with a day 10 FSH of 13.8. Was given the donor egg speech and told I'd have a less than 1% of IVF working for us. Well, lo and behold I did IVF using a MDL protocol and I managed to produce 15+ follicles/14 eggs retrieved/11 mature/8 resulting embryos. I went yesterday for a 3-day transfer and found out that my embryos are growing very slowly. I have a grade 1 (top grade) embryo that's at 6-cells and the remainder are 5-cells. Three of them are pretty badly fragmented. The RE believes that I have an egg quality issue based on the slow growth of the embryos. We decided not to transfer and to wait 2-3 more days to see if any make it to blastocysts. I'm extremely nervous to say the least. The RE mentioned that if we don't get any blastocysts, then in the next cycle he will tweek the protocol in an attempt to improve egg quality. He also mentioned that metformin would be used, since my ovaries are producing quite a few follicles. Well this has caused a bit of confusion for me and I was hoping you could shed some light on the following questions?

- Can slow growing embryos make it to blastocyst stage, or do you believe that it is a true indication that the eggs were of poor quality?
- Is there an average % rate for predicting the number of embryos that make it to blastocyst stage? I'd read somewhere, that it is in the range of 20%, but am not sure of this.
- How can metformin improve egg quality in an individual that doesn't have PCOS? Have you ever heard of this being included as part of a protocol in a patient that has high FSH?
- If indeed there is an androgen issue causing my poor egg quality, are there any other tests I should consider before commencing another IVF cycle?

Thank you in advance for you reply.

:)

Dr Smith - June 29th, 2006 8:13 AM

A1. Slow growing embryos can make it to the blastocyst stage - eventually (Day 6-7). However, there are other indications of poor egg quality. Excessive fragmentation is a sign atretic embryos from poor quality eggs. It may be possible to tweak the stimulation to improve egg quality. But if you get the same results on a subsequent cycle, it would be pretty conclusive that there is an egg problem.

A2. Blastocyst development rate for different age goups (approximate):

Patients <30; about 50%
Patients 30-35; about 40%
Patients 35-40; about 30%
Patients 40-42; about 20%
Patients >42; anyone's guess

A3. I have seen no data to support the notion that Metformin improves egg quality per se, even in PCOS patients. Metformin addresses the insulin resistance problem that a subset of PCOS patients have. You may want to ask your docotor what their rationale is.

A4. There are treatments (medicine you can take) for high androgen levels. You should discuss that with your doctor too. I'm not a physican, so I can't answer true medical questions. Dr Jacob's Infertility 101 Message Board is also a source. Dr Jacobs is a RE.


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